• Southern Health suggests it has missed out on £3m of STF due to fines relating to historic cases
  • NHS Improvement refused to exclude fines and legal costs from “control total” calculation

NHS Improvement has refused to relax a trust’s financial “control total” despite the local finance director arguing that “mistakes of the past” had resulted in the target being missed.

During 2017-18, Southern Health Foundation Trust incurred £2.1m of fines after the deaths of inpatients Connor Sparrowhawk and Teresa Colvin, and serious injuries suffered by other patients between 2010 and 2013.

The cases had resulted in prosecutions from the Care Quality Commission and Health and Safety Executive, for which the trust spent £600,000 on legal fees.

The fines meant Southern Health missed its £2.9m surplus control total, and therefore also missed out on £1.1m of “sustainability and transformation funding” from NHS Improvement in quarter four. It also meant the trust lost access to “bonus” payments from the STF.

In total, the impact of the fines and lost STF could cost the trust up to £5m, said finance director Paula Anderson.

In a letter to NHSI, obtained by HSJ through a freedom of information request, Ms Anderson asked for the fines and legal fees to be excluded from the calculation of the control total due to the “disproportionate impact” on the trust.

She said there has been “much comment about the appropriateness of one public sector body fining another”, particularly given the “public perception of pressures” within the NHS, and “how the mistakes of the past could impact patient care for today’s patients”.

The NHS could choose to manage the STF impact differently, and “not worsen the position unnecessarily for Hampshire patients”, Ms Anderson said.

She added the trust could have sold Slade House, where Connor Sparrowhawk died, and earned up to £8m, but chose to transfer the facility to Oxford Health FT as part of a divestment of its learning disability service in July 2017.

Finally, she warned the cash impact of the losses would affect the trust’s capital programme.

The trust is planning to improve secure services provided from its Ravenswood unit, which do not meet all requirements of the services commissioned by NHS England.

It is also hoping to provide 14 new low secure inpatient child and adolescent mental health beds on its Tatchbury site at a cost of £12m, which Ms Anderson said was a “crucial” element of the national programme for child and adolescent mental health services.

“The trust is not seeking to avoid the impact of the fine, just the additional impact that losing the STF will have”, Ms Anderson wrote.

However, the request was refused by NHSI’s finance director Elizabeth O’Mahony.

An NHSI spokeswoman told HSJ the lag between the events and prosecution was “entirely beyond NHSI’s control”, but “it is right trusts are held to account when there are failings of this nature”.

She said decision making over STF was “fair, transparent, and consistent” and that “exceptions to the overriding rules are only made on a very exceptional basis, where circumstances are beyond a trust’s control”.

Asked about the impact to the trust’s capital plans, the spokeswoman said the trust should seek to secure the necessary funding through established routes.

In May, HSJ revealed that Barts Health Trust had retained access to its full allocation of STF, worth £39m, despite missing its original control total by £60m.

When asked to explain the rationale behind this at the time, NHSI did not respond.